Health Advisory: Viral Gastrointestinal Illness in the Camp Setting

Transcription

1 Richard F. Daines, M.D. Commissioner Wendy E. Saunders Chief of Staff August 4, 2008 Health Advisory: Viral Gastrointestinal Illness in the Camp Setting Please distribute immediately to Camp Director, Camp Physician/Medical Director, Camp Nurse, Camp Emergency Medical Services, Camp Infirmary Services Staff Note: This advisory was originally posted on the New York State Department of Health s Health Alert Network (HAN) on August 1, Two updates have been made to the advisory; the changes are indicated by underlined text on pages 2 and 3. Over the past month, there has been a significant increase in the number of gastrointestinal outbreaks of suspected viral etiology reported in camps throughout New York State. Many of these outbreaks are ongoing and there is concern that some children arriving at summer camp may be affected and could possibly transmit the disease if appropriate safeguards are not in place. The following information will provide Camp Directors and other staff with guidance on detecting and responding to viral gastrointestinal illness. BACKGROUND Caliciviruses (commonly known as norovirus or Norwalk virus) are a common causative agent of outbreaks of viral gastrointestinal (GI) illness. Infection is characterized as a self-limiting illness with clinical symptoms of nausea, vomiting, diarrhea, abdominal pain, low grade fever, or a combination of these symptoms. The symptoms can last hours, with an incubation period of hours. Transmission is by person-to-person spread by the fecal-oral route or through contaminated food or water. People infected with norovirus shed the virus in their feces before symptoms develop and for several days to several weeks after their illness has resolved. Small amounts of feces (not visible) containing the organism can contaminate hands and surfaces, and can be swallowed by someone else and cause illness. The virus is also present in vomitus and may spread short distances through the air when a person vomits or while the vomit is being cleaned-up. Norovirus is very contagious because it takes a very small amount of virus to make a person ill. Persons who are ill with vomiting and diarrhea should drink plenty of fluids to prevent dehydration. Persons with underlying medical conditions such as diabetes or metabolic disorders Page 1 of 5

2 should contact their medical provider at the first sign of GI illness. Occasionally some individuals may need to be hospitalized to receive intravenous fluids to reverse dehydration. PREVENTION AND CONTROL The following are recommended to prevent the introduction and spread of gastrointestinal (GI) illness at camp: Careful hand washing is the most effective means of preventing the spread of GI illness. Since GI illness spreads though fecal matter, prevention requires washing hands carefully with soap and warm, running water for 20 seconds after using the toilet. Additionally, all campers and staff should wash their hands frequently throughout the day and before eating and preparing food. Camp counselors and caregivers should supervise and/or help young children wash their hands thoroughly and properly. Hand washing is especially important after going to the bathroom. Hands should also be washed on arrival at camp and before eating or drinking. o Hands should be washed with soap and warm water prior to performing ceremonial hand washing (e.g., Asher Yatzar or Netilat Yadayim). Counselors should be advised to regularly wash high touch surfaces, toys, sports equipment, table tops, faucets, door handles, computer keyboards and the handles of communal washing cups using a bleach solution of 1 part household bleach to 50 parts water. Ensure that all food service staff (including campers who occasionally handle foods) wash their hands thoroughly before food handling and immediately after toilet visits. Adequate supplies of hand washing soap and disposable towels must be available at all times in food service and dining areas, bathrooms, and other areas where toileting or food service may occur. Alcohol-based hand sanitizers should be used if soap and water is not available. Consider making alcohol-based hand sanitizers available throughout the camp. o Exercise caution and ensure proper supervision of young children using alcoholbased sanitizers. o When hands are visibly soiled, after toileting, and after cleaning vomitus or other potentially contaminated body fluids, alcohol-based sanitizers should not substitute for soap and water when possible. Conduct regular cleaning and disinfection of bathroom facilities. Disinfection can be accomplished with chlorine bleach (at a recommended concentration of 1 part household bleach to 50 parts water) to be used to disinfect hard, non-porous environmental surfaces. Educate housekeeping staff on proper use of personal protective equipment including the use of a mask when cleaning vomitus. Mattress covers soiled with vomitus or feces should be removed and promptly cleaned and disinfected or discarded. Dining areas, including tables, should be wiped down after each use using a bleach solution of 1 part household bleach per 50 parts water. If a person vomits or has a fecal accident in the dining hall, clean the affected area immediately. Food contact surfaces and dining tables near the accident should be sprayed using a bleach solution of 1 part Page 2 of 5

3 household bleach per 10 parts water. Allow surfaces to air dry. Food that was in the area when the accident occurred should be thrown away. Handle linens, sleeping bags, and clothing soiled with vomitus or feces as little as possible. These items should be laundered with detergent in hot water (at least 140 F) at the maximum cycle length and then machine dried on the highest heat setting. If there are no laundry facilities onsite capable of reaching 140 F, soiled items should be double bagged (using plastic bags) and taken offsite for proper washing and drying. If soiled items are sent home, instruct parents or caregivers of the proper washing and drying procedures. REPORTING Camps are required to report outbreaks of GI illness to the local health department. Local and state health departments are available to consult on prevention and control of any case or outbreak of GI illness in a camp. MANAGEMENT OF SUSPECTED VIRAL GASTROENTERITIS Prompt diagnosis is essential to control spread of viral gastrointestinal illness. The following is recommended for camps with staff or campers experiencing gastrointestinal illness: Screen campers and staff members upon entry to camp for current gastrointestinal illness, such as vomiting and or diarrhea. Any symptomatic campers or staff members should be referred for medical evaluation. Depending on the situation, the local public health agency may recommend collecting stool or vomitus specimens from ill campers and staff for laboratory testing to try to determine the organism causing the illness. Camps should maintain incident and health center visit logs to document and monitor illnesses and injuries. Logs should include at a minimum the date, time, name, living area/group, and the reason for the visit. In the event of an outbreak, develop and maintain a log/linelist of ill campers and staff. This list should include the name, age, sex, camper or staff, unit/dorm/tent/cabin, onset date/time, symptoms, duration (hours), specimens collected, treatment/action (treatment provided, went home, etc), job duties (for staff). A sample log/list is included in this advisory. Discontinue salad and sandwich bars, family-style service, and buffets. Increase frequency of high contact surface cleaning, including bathrooms and food preparation and dining areas. If GI illness is present, a bleach solution of 1 part household bleach per 10 parts water should be used for cleaning surfaces soiled with stool or vomitus and for cleaning and disinfection of bathroom facilities. RESTRICTIONS At day camps, campers or staff members with GI illness must be immediately isolated at the camp s infirmary or holding area and arrangements made to send them home. Ill individuals must not return to camp until after their symptoms have resolved for 72 hours. Page 3 of 5

4 At overnight camps, campers or staff members with GI illness must be isolated from other campers in the infirmary or a location separate from uninfected campers and staff until symptoms have resolved for 72 hours. o Cohorting (housing together) campers or staff with gastrointestinal illness may be considered only after consultation with the local health department. o Depending on the camp context and duration, camp directors may want to consider sending home campers and staff with GI illness. Persons with any GI illness should not use recreational water venues (pools, lakes, aquatic spray grounds, etc.) until 72 hours after symptoms resolve. Any food service or other staff or campers with viral GI illness should be excluded from handling food and beverages until 72 hours after symptoms resolve, even if they are feeling well sooner. Campers or staff members with GI illness may return to regular camp activities after 72 hours after symptoms resolve and are able to participate in camp activities. Limit entry/exit from camp; postpone or restrict activities involving visitors, including other camps until 72 hours after the last case of GI illness presented. Any camper and staff with viral GI illness who is sent home should seek prompt medical attention. Camps should provide a letter notifying parents and providers of the viral gastrointestinal outbreak. Please contact your local health department for assistance or template letters that can be used. Additional information on viral GI Illness can be obtained at the New York State Department of Health website at: A fact sheet and an Outbreak Case History form are attached for your use and distribution. Links for posters are listed below. If there are any questions, contact your local health department. Enc: Norovirus (Norwalk Virus Infection) Fact Sheet ( Handwashing poster ( Six Please Fact Sheet ( Healthy Swimming poster ( Page 4 of 5

5 NEW YORK STATE DEPARTMENT OF HEALTH Outbreak Case Histories* Name of Children s Camp Date of Outbreak ehips Incident # Illness Information Status Sex Severity Signs and Symptoms Age Time of Initial Symptom Incubation Period No. Name of Person** Bunk/Group Camper Dev. Dis. Camper CIT/JR Counselor Counselor Other Staff Other * Male Female Duration of Illness Physician seen Hospitalized Death Day Hour Nausea Vomiting Abdominal Cramps Diarrhea Fever Sore Throat Total Bureau of Community Environmental Health and Food Protection Children s Camp Program * Follow Environmental Health Manual Procedure CSFP 803 for Foodborne Outbreaks ** Collect addresses and phone numbers for follow-up Information received by: Information reviewed by: Title: Title: Page 5 of 5

6 New York State Department of Health Norwalk Virus Infection (calicivirus) Last Reviewed: November 2006 What is Norwalk virus infection? Norwalk virus infection is a gastrointestinal illness that occurs sporadically or in outbreaks. The virus was first identified during a gastroenteritis outbreak in Norwalk, Ohio, in There are a number of strains of Norwalk virus which are also referred to as calicivirus. Who gets Norwalk virus infection? Anyone can become infected. It only occurs in humans and is found worldwide. How is it spread? Norwalk viruses are spread by exposure to infected people or contaminated food and water. The virus is passed in stool and vomit. Outbreaks have been linked to sick food handlers, contaminated shellfish or water contaminated with sewage. It is generally spread from person to person by direct contact, but some medical reports suggest that the virus can spread through the air during vomiting. What are the symptoms? Although the virus is easy to spread, serious illness rarely occurs. The most common symptoms include nausea, vomiting, and stomach cramps. Diarrhea may occasionally accompany vomiting. Fever is usually low grade or absent. Infected people generally recover in one to two days. How soon after exposure do symptoms appear? The incubation period is one to two days. What is the treatment for Norwalk virus infection? No specific treatment is available. Persons who become dehydrated might need to be rehydrated by taking liquids by mouth. Occasionally patients may need to be hospitalized to receive intravenous fluids. How can Norwalk virus infection be prevented? The following recommendations may reduce the risk of acquiring or spreading the infection: wash hands thoroughly after each toilet visit and before preparing food. people who experience nausea, vomiting or diarrhea should not attend school or work and should not handle food for others while ill. avoid drinking untreated water. cook shellfish thoroughly before eating. Revised: June 2004